Individual
DR. JOHN WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, NEONATAL PERINATAL FELLOWSHIP, JACKSON, MS 39216-4500
(601) 815-8489
(601) 984-2086
Mailing address
4034 N STATE ST, JACKSON, MS 39206-5754
(304) 881-1007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
T-3234
MS
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
T-3234
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/22/2016
Last updated
06/27/2019
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